Pre-Activity Readiness Questionnaire Form (PAR-Q-

Form)

Personal Details
First Name: Middle Name: Surname:

Date of Birth DD MM YYYY Male/Female

Age

Address

Town County Postcode

Email

Tel Home Tel Mobile

Emergency Contact Tel

Medical Questions
Answer the following questions as honestly as you can and provide as much relevant additional
information. Answer the following questions by placing a tick in either the Yes or No boxes ( if you should
answer Yes to any of the questions please provide further information in the space provided)

Do you currently or have you ever suffered from any of the following conditions?

1) Heart problems? Yes □ No □ If yes, please provide details below

2) Circulatory problems? Yes □ No □

3) Blood pressure problems? Yes □ No □
4) Joint, movement problems? Yes □ No □
5) Feel dizzy or imbalance during exercise? Yes □ No □
6) Currently pregnant or recently given birth? Yes □ No □
Health History
Do you currently receive medical care or do any of the following affect you?

7) Back/spinal pain? Yes □ No □ If yes, please provide details below

8) Headaches or migraines? Yes □ No □

9) Have you recently had surgery? Yes □ No □
10) Currently being prescribed medication? Yes □ No □
11) Recently finished a course of medication? Yes □ No □
12) Diabetes? Yes □ No □
13) Asthma or breathing problems? Yes □ No □
Is there is any other reason that you believe may prevent you from taking part in any regular activity?

Declaration
I have answered all question in this form honestly and I am aware that if I have answered yes to any of the questions I will need to
consult my GP before commencing an exercise program if I am affected by any of the questions mentioned in this form or at a later
date I agree to inform my personal trainer or instructor on any changes in health or fitness.
Date: / /20
Signed: Print Name:
 Pre-Activity Readiness Questionnaire & Health History
Action Required for YES Responses
What is the PARQ and why do I need to complete it?

The PARQ (Pre Activity Readiness Questionnaire) is an industry-standard for fitness professionals and fitness faculties to use when
screening clients for exercise.
The reason for doing this is to ensure you (the client) is healthy and will not be put at risk from taking part in a fitness programme or
regular exercise.
Fitness professionals are not medical professionals and cannot commence a fitness programme with a client who has provided
positive responses to a PARQ. In this case, the client will be referred to their local GP to ensure they are ready for exercise.

A yes to the first 6 questions on the PARQ form overleaf will normally result in a referral to your GP however a YES response to
questions 7 to 13 depending on the circumstances of each question will not normally require GP consent.

The guide below is our policy and we must enforce on all occasions with no exceptions.

Action Required for YES Responses to PAR-Q Questions

1) Heart problems? Refer to GP
2) Circulatory problems? Refer to GP
3) Blood pressure problems? Check blood pressure
o If blood pressure is lower than 160/95 mmHg no referral is necessary
o If blood pressure is between 140/90 and 160/95 induct on CV only (Advice to see Doctor)
o If blood pressure is between 160/95 and 180/100 accept on GP referral only
o If blood pressure is 180/100 or higher will not be accepted
4) Joint, movement problems? Refer to GP
5) Feel dizzy or imbalance during exercise? Refer to GP
6) Currently pregnant or recently given birth? Ask more questions about pregnancy/birth:
o If pregnant and after the first three months, no referral is necessary
o If pregnant, within the first three months and was exercising regularly before became
pregnant, no referral is necessary
o If pregnant within the first three months and not already exercising regularly, refer to GP
o If had a natural birth less than 6 weeks ago refer to GP
o If had caesarean section less than 10 weeks ago refer to GP

Action Required for YES Responses to Health History Questions

7) Back/spinal pain? Find out limiting factors, i.e. movement and pain. If in doubt refer to GP
8) Headaches or migraines? Be aware that people who suffer from headaches on a regular basis may
develop a headache caused by exercise while exercising.
9) Have you recently had surgery? Find out how recent surgery was and what it was if very recent refer
to GP.
10) Currently being prescribed medication? Find out more information about the medicine and possible
side effects, if in doubt refer to GP
11) Recently finished a course of medication? Find out about medication that was taken, if in doubt refer
to GP
12) Diabetes? Not a limiting factor but will need to be aware of the condition, encourage them to carry a
snack and ideally, they should take their blood sugar level before and after exercise. Best not to
exercise if their level is too low or too high immediately before exercising. Ensure the client drinks
plenty of water before, during and after exercise. If in doubt, refer to GP.
13) Asthma or breathing problems? If the inhaler is required, ensure they have it with them and re-
schedule induction if they don’t.